Can ACOs Crack the Healthcare Payment Code?

It's not just the volume of patients that will strain the system. More patients means provider organizations need more physicians, and hospitals and systems are willing to fill the void by employing, acquiring, or contracting as necessary. Over the next 12 to 36 months, 74% of hospital leaders surveyed said they plan to employ a greater number of physicians. Many MDs are already seeking employment, while news of physician groups being acquired is now a regular occurrence.

Change, of course, begets change. Under PPACA, there will be shift away from the fee-for-service model, and providers will be tasked with delivering better care at lower costs. Figuring out how to do that is another pain point, and the work is just getting underway. The patient-centered medical home model and accountable care organizations, may deliver on both fronts, but are largely untested.

Samitt, for one, who is president and CEO of Dean Health System in Madison, Wisc., believes ACOs could facilitate increased collaboration, better patient outcomes, and a better value.

And Paul Keckley, executive director, Deloitte Center for health Solutions wrote in a memo this week: “It’s plausible to believe that alignment of physicians, hospitals and long-term care providers into local integrated delivery systems, a shift from volume to outcomes-based payments and adoption of a national standard of care based on evidence might bend the curve. Time will tell."

Fred J. Pane (9/23/2010 at 9:13 AM)
There have been collaborative models developed over the years that can be benchmarked, when it comes to ACO's. Geisinger, Intermountain, to name two. They have had collaborative models with their physicians and a focus on prevention and treatment of disease across the continuum. There is one focus, to improve healthcare and the outcomes in patients. That is why hospitals operate (their mission to the community) and it is why physicians and other healthcare providers help patients. It has just been that alignment across the continuum of care, has not been there. It hasnot been there for payers also. It will have to be now. About 7-8 years ago I led a teaching hospital administration group to meet with one of our BCBS providers and on behalf of our PPO. We attempeted a p4p model because of the clinical outcomes and paient safety results we were seeing. The payer had no way to address our model.

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